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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 28  |  Issue : 2  |  Page : 215-218

Solar elastosis: Case report and review


1 Department of Oral Medicine and Radiology, Haldia Institute of Dental Sciences and Research, Haldia, West Bengal, India
2 Department of Oral Medicine and Radiology, St. Joseph Dental College and Hospital, Eluru, Andhra Pradesh, India
3 Department of Oral Pathology and Microbiology, Haldia Institute of Dental Sciences and Research, Haldia, West Bengal, India
4 Department of Oral Medicine and Radiology, Kamineni Institute of Dental Sciences, Narketpally, Andhra Pradesh, India

Date of Submission27-Oct-2015
Date of Acceptance21-Nov-2016
Date of Web Publication02-Dec-2016

Correspondence Address:
Tanya Khaitan
Department of Oral Medicine and Radiology, Haldia Institute of Dental Sciences and Research, Haldia - 721 645, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.195143

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   Abstract 

Solar elastosis is degenerative dermal disease of the photodamaged skin, associated with aging and influenced by hereditary factors such as pigmentation, exposure to sunlight and wind. The disease is characterized by the accumulation of abnormal elastic tissue in the dermis. Solar elastotic syndromes include solar elastosis, Favre-Racouchot syndrome, elastotic nodules of the ears, collagenous and elastotic plaques of the hands, and colloid milia. The most common solar elastotic syndrome is solar elastosis. The chief etiological factors contributing to the lesion include chronic exposure to sunlight (ultraviolet, visible, and infrared radiation). Ultraviolet-A radiation causes erythema and its deep penetration into the dermis causes inexplicably chronic photodamage. Here, we present a case report of 32-year-old female with a distinctive clinical presentation.

Keywords: Collagen, photoaging, skin


How to cite this article:
Khaitan T, Pachigola R, Kabiraj A, Ginjupally U. Solar elastosis: Case report and review. J Indian Acad Oral Med Radiol 2016;28:215-8

How to cite this URL:
Khaitan T, Pachigola R, Kabiraj A, Ginjupally U. Solar elastosis: Case report and review. J Indian Acad Oral Med Radiol [serial online] 2016 [cited 2021 Aug 3];28:215-8. Available from: https://www.jiaomr.in/text.asp?2016/28/2/215/195143


   Introduction Top


Skin is a multifaceted and sophisticated tissue differing in several ways from all the other organs in the human body. It is directly exposed to all rigors and hazards of the milieu. Our continued survival on this planet has been made possible only because protective mechanisms of the skin have evolved. First, the mechanically protective and partially permeable outer horny covering to the skin, the stratum corneum, and second, the photoabsorptive melanin pigment system, are included in such mechanisms. Although both adaptations are efficient, they cannot prevent the barrage of climatic insults from causing some permanent damage to the skin's structure. [1],[2]

Photoaging is a condition used to describe the clinical, histologic and functional changes in chronically sun-exposed skin of middle-aged and elderly adults. [2] "Solar elastosis" is such a phenomenon which refers to the accumulation of abnormal elastic tissue in the dermis in response to long-term sun exposure. It is an infrequent degenerative dermatologic disease associated with aging influenced by hereditary factors such as pigmentation and exposure to sunlight and wind. Such skin damage by prolonged exposure to the elements of the weather has often been termed as Sailor's skin or Farmer's skin. [3] Here, we present an exceptional case report of a 32-year-old female with a distinctive clinical presentation.


   Case Report Top


A 32-year-old female reported with multiple decayed teeth in the lower right and left jaw region since 20 days. She was a labourer by occupation and belonged to a remote village in the eastern part of India. The patient was chronically exposed to long periods of sunlight. Her medical, dental and personal histories were non-contributing except for the history of dryness of skin. The vital signs were found to be within satisfactory limits. On general physical examination, the upper and lower limbs showed scaly and wrinkled appearance. The little toe in the lower limb was atrophied [Figure 1] and [Figure 2]. Extraoral examination revealed similar features on the face and neck along with hypopigmented areas, scarring and stretched skin, giving it a mask like appearance. The skin was rough and leathery in texture on palpation. The infraorbital region appeared stretched, making the lower palpebral conjunctiva region evident. The upper vermilion border of the lip seemed to be blended with the surrounding skin [Figure 3]. Intraoral examination showed no abnormality [Figure 4], except for several carious teeth and root stumps.
Figure 1: Upper limbs showing scaly and wrinkled appearance

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Figure 2: Lower limbs showing scaly and wrinkled appearance and atrophy of little toe

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Figure 3: Extraoral photograph of the patient giving mask-like appearance

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Figure 4: Intraoral view showing no abnormality

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The patient was not willing for skin biopsy; hence, histopathological investigations could not be performed. Hematological investigations were done and found to be within normal limits. Based on the documented history, clinical findings and investigations, a diagnosis of solar elastosis was considered. Clinical differential diagnosis of chronic actinic dermatitis, photoallergic contact dermatitis and dermatomyositis were considered. Photopatch test and sensitivity to ultraviolet radiation was performed, which yielded negative results and other conditions were ruled out. Henceforth, a final diagnosis of solar elastosis was confirmed. The patient was referred to a dermatologist for further skin treatment. Topical retinoids (0.05%) and sunscreen with sun protection factor (SPF) of ≥15 was prescribed and the patient was advised to avoid further sun exposure. In regards to dental aspect, the root stumps were extracted and the carious teeth restored.


   Discussion Top


The term solar elastosis refers to histopathologic changes in degenerative dermal elastic tissue that occurs in photodamaged skin. It is also known as actinic elastosis or senile elastosis. Several distinctive entities of solar elastosis have been described based on the combination of anatomic location, clinical appearance, and histopathologic findings. Solar elastotic syndromes include solar elastosis, Favre-Racouchot syndrome, elastotic nodules of the ears, collagenous and elastotic plaques of the hands, and colloid milia. The most common solar elastotic syndrome is solar elastosis. [4]

The primary etiological factor is chronic exposure to sunlight which includes ultraviolet, visible and infrared radiation. Ultraviolet-A radiation causes erythema and its deeper penetration into the dermis causes inexplicably more chronic photodamage compared to Ultraviolet-B. [5] Prolonged sun exposure also leads to an influx of neutrophils packed with potent proteolytic enzymes capable of degrading collagen and particularly the elastic fibers. Neutrophil-derived proteolytic enzymes are considered to be responsible for the extracellular matrix damage. Moreover, neutrophil elastase, a major product of neutrophils and matrix metalloproteinases, has shown to be strongly associated with solar elastosis. The extent of this collagen degradation is dependent upon factors such as the thickness of stratum corneum, melanin pigment and clothing or chemical sunscreens. [6],[7]

This degenerative condition seldom involves oral mucous membrane except for the lips and labial mucosa exposed to sun. It is most commonly seen in the elderly age group. The affected skin appears dry, atrophic, flaccid, giving a wrinkled and leathery appearance with various pigmentary changes. [3] On the lip, there may be mild keratosis and subtle blending of the vermilion border with the skin surface. Clinically, it is manifested in three forms, namely, cutis rhomboidalis represented in the form of thickened skin with furrow giving an appearance of rhomboid network, Dubreiulh' selastoma seen as diffuse plaque-like lesion, and nodular elastoidosis giving a nodular lesion appearance. [8]

Microscopically, solar elastosis shows basophilic degeneration of elastotic fibers in the dermis, separated from the epidermis by a narrow band of normal-appearing collagen (grenz zone) with collagen fibers arranged horizontally. This is best evident with the help of special stains. The degree of elastosis correlates with the cumulative amount of ultraviolet radiation to which the skin has been exposed. [4]

There is no specific treatment for solar elastosis more than that of approaching old age in general. The most effective strategy is prevention of actinic-related damage with sun avoidance, protective tightly woven clothing and wide-brim hat. Treatment modalities such as antioxidants (Vitamin E or beta-carotene), tretinion, alphahydroxy acids and sunscreens have been carried out to modify the severity of acute cutaneous photodamage. A dose-dependent improvement in photodamage is observed after topical retinoid therapy. Treatment with 0.1% tretinoin cream for 10-12 months has shown an 80% increase in collagen I formation. After 12 months of therapy, the condition has been reported to decrease with an increase in the number of fibroblasts in the dermis. [5] Recent skin resurfacing procedures such as ablative Er:YAG laser resurfacing, combination of fractionated CO2 laser resurfacing with platelet-rich plasma, laser radiofrequency, and neurotoxin injections with botulinum toxin have been used in attempts to improve the cosmetic appearance of solar elastosis. [9]


   Conclusion Top


Therefore, counseling and suitable approach of the patient is important for the oral and general physician as there is a psychosocial impact because of its intimate but incompletely understood relationship to skin cancer, as well as various functional losses in the skin.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Patterson JW. Weedon's Skin Pathology. 4 th ed. China: Churchill Livingstone Elsevier; 2016. p. 391-2.  Back to cited text no. 1
    
2.
Lim HW, Soter NA. Clinical photomedicine. Marcel Decker Inc.; 1993. p. 95-7.  Back to cited text no. 2
    
3.
Rajendran R, Sivapathasundharam B. Shafer's textbook of oral pathology. 5 th ed. New Delhi: Elsevier; 2006. p. 1151.  Back to cited text no. 3
    
4.
Heng JK, Aw DC, Tan KB. Solar elastosis in its papular form: Uncommon, mistakable. Case Rep Dermatol 2014;6:124-8.  Back to cited text no. 4
    
5.
Yeung KH. Solar elastotic syndrome. Hong Kong Dermatol Venereol Bull 2000;8:114-6.  Back to cited text no. 5
    
6.
Rijken F, Bruijnzeel PL. The pathogenesis of photoaging: The role of neutrophils and neutrophil-derived enzymes. J Investig Dermatol Symp Proc 2009;14:67-72.  Back to cited text no. 6
    
7.
Yamauchi M, Prisayanh P, Hique Z, Woodley DT. Collagen cross-linking in sun-exposed and unexposed sites of aged human skin. J Invest Dermatol 1991;97:938-41.  Back to cited text no. 7
    
8.
Ghom AG. Textbook of Oral medicine. New Delhi: Jaypee Brothers Medical Publishers; 2014. p. 535.  Back to cited text no. 8
    
9.
Loesch MM, Somani AK, Kingsley MM, Travers JB, Spandau DF. Skin resurfacing procedures: New and emerging options. Clin Cosmet Investig Dermatol 2014;7:231-41.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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